I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

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Saturday, June 9, 2007

First--remember that the wound/cut/incision is not "technically" healed at this point. The wound is just now entering that third phase, the maturation phase, of healing. The stitches need to come out early so that there will not be "stitch marks" or "rail road marks" from the stitches themselves. The area needs to still be protected from tension. Steristrips can do this, but so can a piece of paper tape applied along (or across) the "healed" scar. Both of these allow the strip or tape to have the tension placed on them rather than actual scar. The tensions are the scar will vary depending on its location. The shoulder gets a lot of tension as use of the arm is allowed (If we didn't allow use of the shoulder, it could "freeze" up--that's worse than a wide scar.) The breast/chest skin gets some tension with arm use, but can be decreased by not allowing backward motions of the arm (ie vacuuming) or full stretching, as in reaching for the top shelf.

Second--protect the scar from the sun. Apply sunscreen daily to the scar, if exposed (face, neck, hand), for 6 months or more. This will allow the red color (as the increased capillaries are absorbed) to fade.

Third--scar massage helps in the "realignment" of the collagen during the maturation phase (up to two years). It is easier to do scar massage if you use something like cocoa butter, vitamin E, Mederma, Aquafor, or just a favorite lotion. The key here is to do it. Gently massage along the scar. Gently "pinch" the scar up if the scar feels like it is trying to "stick" or adhere to the underlying tissues.

Fourth--If the scar allows (won't work on areas with great movement), silicone sheeting products can be used. It is hard to use both this and some of the scar massage suggestions at the same time. The Mederma or vitamin E, etc must be cleasned off the skin really well befor applying the silicone sheeting.

Scar revisions are not done for a minimal of 6 months, as we know that scars change, flatten, and fade. Exceptions to this rule are when the scar is obviously creating a tether across a joint (can not straighten the elbow) or deforming (pulling the lower eyelid away from the eye). If the scar appears to be getting "puffier" or thicker, it can often be helpful to inject the scar with Kenalog. This must be done carefully, as the injection can thin the scar/skin (atrophy) and decrease pigmentation in the skin. These risks must be weighed against the benefits expected to be gained.

Other things that can help with healing include: not smoking, good nutrition, and keeping other disease processes under control (ie diabetesand hypothroidism).

i'd like to echo quilting queen's thanks. very methodical and thorough information. my situation is similar, but with a tumor closer to the tear duct. do you have a favorite sunscreen? i find most irritate my eyes when i run or exercise.

B -- I use MD Forte Total Protector SPF 30 for my face. I have not had trouble with it irritating my eyes, but I may not put it as close to the lids as you do. I tend to leave a quarter inch around the lashes. Try one for the face and/or for kid's. You should find them less irritating.

Or can you do like I do (above) and then wear sun glasses and/or a hat? That would protect your eyelid skin well.

I really appreciate this article. My daughter recently had surgery for a broken upper arm that required an incision to re-set. She just got her cast off and so only now can I put on tape or cream or anything to help the scarring. Can you please provide specifics on how/where to buy the tape or cream? Also, when you say across the scar, are you meaning perpendicular to the scar, as in butterfly bandaids? Thanks!

I'm reading everything I can about scars. Love your website and recommendations Just had bilateral breast implant reconstruction surgery a year after my NAC mastectomy. In past year had medial skin tears due to seroma. Bad keloid in chest center (at least I healed) along with scars on side of breast. Surgeon says I scar badly oddly enough for a health/fitness fanatic but she doesn't have any other recommendations other than "be proud of survivor scars" or use a creme if you want to waste money! This is not helpful. Unfortunately I can't have steroid shots because needles not advised around implant. I've found Mederma to be useless. Have you heard of NeoCutis which is sold as scar creme in Europe? thanks. anne

RLB -- I just had MOHS surgery yesterday on my forehead. Kinda shocked by the size of the crater left behind. Since I am an actor by trade I am understandably concerned about scarring. Your advice is much appreciated. In fact I giving a copy to my dermatologist, to pass on to others, when I get the stitches removed next week. ThanxSCMU

Thank you so much for this great advice doctor. I have stitches on my nose and I wanna use tape this time because the scar always spreads. Do I have to leave the tape on the scar 24 hours a day?? And how long would you suggest??

Do these techniques apply healing a scrape too? My 4 year old took a nose dive onto concrete and scraped his nose pretty bad. I read another site about scar prevention, so I covered it with a bandaid for about 3-4 days, but I took it off yesterday as the skin under the sticky part of the bandaid was looking pretty red and raw. Should I put it back on?

There is just a thin light colored scab at this point. (The bandaid clearly helped as the scraped area under his nose that didn't get a bandaid has a bigger darker thicker scab.)

Other than sunscreen, what else would you recommend at this point? I'm only worried about this because a smaller scrape on his wrist about 6 months ago left a scar and I don't want this to happen to his cute little face!

Your information was extremely helpful! I just got the stictches out of an inverted t-shaped insision right at the base of my neck and since it is front and center (even with scarves being in fashion right now!) I would like to do everything I can to minimize how visible it is. It would be really helpful if you could explain more about how to do the massage (i.e. how soon can I start after stitches are removed, how long should the area be massaged and how often, what direction?). The area feels weird to touch because some areas have no feeling and other areas seem hypersensitive, how long does that last? Thanks so much!!

Anon, you should ask your surgeon when it is okay for you to begin scar massage. When it is okay, I think it is best done in-line with the scar. Use Mederma, lotion, or some lotion and rub in the direction of the scar. Rub gently but firmly. Do this a couple of times a day for a couple of minutes.

The area "feels wierd" because some of the fine skin nerves were damaged but will usually return to normal. It can take a few weeks to several months for this to happen.

Thanks for your information that is very helpful for me. my name is kim and my son who is 3years old had stitches under his eye in 10days. The sticky bandage just came out. The doctor just recommended to use Talsyn cream after his sticky came out. As you said if he got a steri strip, how can I put the Mederma and sunscreen or massage for scar? when is good time to put steri strip and how long and how about Talsyn cream?

My scar will be a thyroidectomy scar and I'm glad I came across this post. Aside from applying sunscreen daily and perhaps some vitamin E, what about applying something antibacterial like Polysporin daily as well?

How long do you think it will take for the scar to become significantly less noticeable?

Thank u for this excellent article. My 3 year old daughter fell and got 3 stitches near her right eyebrow. After 4 days daughter took out the stitces yesterday. Doctor did not put any tape on it. So when should I cover it with tape???

My 8-yo little girl has a new jagged 2-in long 1/4-in deep laceration on her shin (4 days old now from being pushed down on a planter of rough rocks on Halloween) with about 15 tiny stitches inside & out. It looked so smooth & flat up until last night but today I let her return to school where she fell down and tonight it was very slightly split, oozing and raised. Is it too late to get it "reset" back to smooth & flat? With 100's of physicians here in Orange County (CA), I'm at a loss for which type of physician to seek. The physicians assistant in the ER at Childrens Hospital OC did an excellent suture job. To lessen the scarring, he recommended minimum 4 weeks of no activity since the skin on the leg (shin) is so tight. But my very active 8-yo found it to difficult to stay away from the handball courts at recess, so going forward I'm going to bring her home before 1st recess each day (so the school will get paid for her attendance) and homeschool her for rest of each day for the next few weeks. Any advice on whether it can be "reset" and by which type of professional - would be greatly appreciated.

Mom-with-activekids, I must remind you that I'm not your child's treating physician, but at this point I would most likely just watch it. Use a secure band-aid on it daily to protect it and to "splint" it. Your pediatrician may be of help in getting you in to see a plastic surgeon if you are concerned. If the wound hasn't opened, most will watch at this stage. Most won't do a scar revision for 6 months or more as Mother Nature often takes care of fading and flattening scars for us. Take care.

This is the greatest article I've read ever since my 4-year old son got injured in his classroom and had 5 stitches right above his left eyebrow. His stitches will be taken off in a couple of days. So following the info from your article, is this what I should do once his stitches are off?

(1) No need for tape since no much tension in that area;(2) Put sun-screen daily ever since for 6 months or longer;(3) Use lotion or something else to do scar massage, along the scar, twice daily ever since for 2 years.

My son's scar goes not exactly horizontal, but a little toward diagonal to the eyebrow. Will do the scar massage anyway just to make myself feel like I am doing the mum job.

Thanks a lot for your reply, truly! I did not really expect I would be able to get a reply message from you. Thanks you!

I'll try to put more comments along the way my son's scar evolves. My dad said the scar should eventually disappear as long as it's not infected. But my parents-in-law said it will stay for ever. I got all kinds of different comments from various people including the doctors as well.

I personally believe the scar will disappear, at least visually disappeared, completely, with my husband and my own effort. I'd like to show it to them. Thanks again for your support!

Thank you for the article as it's been very helpful. Two weeks ago I was bitten by a dog right under my eye and it angles with the curvature under my eye. I was told that the natural curve was lucky. The doctor used absorbable stitches that after 10 days were still sitting in my face, so I cut them out. I am concerned about the stitches themselves leaving a scar as they are definitely raised bumps right now. I am going to try the tape and the massage, especially since I play a contact sport and can only imagine how much pulling is happening on my face. I just returned to my activities 4 days ago, but like I said, the face skin does get raked and taught/pulled while wrestling. Will the tape while wrestling help this? And what to do about the train tracks?

My 9yo daughter literally fell on her face off a ledge, and basically has a red scrape down the center of her face. She has 7 vertical stitches between her lip and nose. She is very worried about scarring on her face. a) Does it matter who takes her stitches out - plastic surgeon v. pediatrician, or does that not have any bearing on scarring? b) What is the best approach to reduce her scarring from the stitches and from the scrapes on her nose and forehead? Thank you!

Thank you so much for this information. My daughter fell when she was 1 years old and has a scar on her forehead (about an inch or less) which left the "railroad tracks" appearance. The surgeon used stitches that dissolved on their own-obviously they were in too long. The scar looks rather smooth and isn't red, it's only slightly raised, my problem with it is the "railroad track" appearance. Is there ANYTHING I can do about that??? I have Bio-Oil and Mederma which I will try. Will the marks improve or fade more as she gets older and her face gets bigger?? She is almost 2 now.

Anon (8-22-10), your son's scar will most likely continue to improve, but the "railroad" marks may not completely fade. As he gets older, you and he will have to decide whether it faded enough. Best to you.

RLB-what are my options in the future if we find it is still noticible? and is there anything in the meantime that I can do to help diminish it's appearance? would you suggest massage (in what direction should I massage? and mederma or bio-oil (purcellin oil), or scar-away silicone gel? thank you again.

My two year old daughter sustained a tearing laceration this summer with seven sutures. The wound has healed up nicely; however, there remains a thin black line (the size of your pinky nail)discoloration directly beneath the first layer of skin-appear to be old blood trapped between two layers of skin. It doesn't seem like the discoloration is improving any. I'm wondering if her body will reabsorb the debris over time or if I will have to have the scar revised in order to get rid of the dicoloration. I don't want my daughter to have something that looks like a speck of dirt on her cheek for the rest of her life. I massage mederma and vitamin E oil into her face a few times each day and within the past few days, I have noticed that on the very surface of her skin at the scar line, the flesh appears to be making tiny raised bubbles. What could be happening? What can I do to encourage her body to reabsorb the dried blood that seems to be trapped under her skin?

My toddler has a 3 month old scar horizontally on her forehead. She had dissolvable sutures placed that didn't dissolve until 10-14 days. I have tried massaging the skin with Vit E which caused dermatitis. I use Mederma SPF now and silicone gels sheets 10-16 hours a day. Her scar is very red, but not raised. She is outside daily with her school. Does the silicone gel sheet protect her from the sun's UV light? Or should I remove the sheet and apply sun block only while she is at school? What else can I do to improve the redness to her scar that is directly on her forehead? Thank you in advance!!

Thank you for the information...it is very helpful. Do you have any recommendations for scar prevention from several cat scratches on the face? 2 days ago, I was scratched on the face by my cat (unintentionally)...there are several scratches that run from just below my left eye down to my chin. Most seem to be fairly superficial...just like an ordinary scratch...but one in particular gets to be pretty deep down by my chin. I cleaned all the scratches out well with both soap and water and hydrogen peroxide, and I've been putting Neosporin ointment on them since it happened. Nothing looks infected right now, but I'm terribly worried about the scratches leaving scars. Is there anything else that I can do now to prevent any scars from forming?

Thank you for the great article, my wife fell on her chin and had a horizontal cut in the lower chin that ended up with 4 stitches, yesterday was day 5 and she got stitches removed, how soon can we start the message? And usually for how many minutes per day should it be done ? Would she benefit more from silicone sheets or the message?Thank you and appreciate your help.

Maher, she will benefit most from the one she will use (regarding massage vs sheeting). I would let my patients begin the scar massage (if the healing is good) on the day I remove the stitches. She may want to check with her physician. A few minutes a couple of times a day (think rubbing on sunscreen or lotion) is good.

Interesting information. I too just had Mohs done on my nose, leaving an awesome suture line up the side of my nose and across the front. These are definitely some good tips for now (just got the sutures out) and in the upcoming months and years, it looks like. :)

I am a in my 30's and have and will continue to need chronic abdominal surgery. The scar always keloids. I had surgery earlier this month, and the old scar was excised. The scar is now 6 inches long and has started to show signs of keloid. I am going to start using Mederma, but is there anything else I can use inconjunction with that to try and prevent the keloid from worsening.Thanks for your input.

Just had some skin on my back removed about 1 week ago due to precancerous moles with a wide margin. The dermatologist placed dissolvable sutures under my skin. I'm a bit worried about scarring because it is very raised. Is this due to the fact the sutures are under the skin? How long should it take them to dissolve and when can I begin scar massage/silicone sheets?

I had MOHS surgery a month ago and had disolving stiches inside and out. I use scar dc at night and just started massaging since my doctor said to wait a month to do so. I did also keep it covered the first two weeks and neosporin the last two. I noticed while massaging, I have one area that is more raised and makes a squishy noise, is this something I should get checked?

Thanks Dr. Bates for the paper tape suggestion! I just removed the last 2 of 6 stitches from a lac 1 cm above my wrist 5 days ago, after they'd been in for 13 days, and my scar was hurting. I took the first 4 out after 10 days, but there was still minor swelling at the center of the wound so I left 2 in for another 3 days. As soon as I applied the paper tape for support the pain stopped. I have it right up against but not touching the scar, it covers the railroad tracks nicely, and disguises a still angry looking scar. I will be massaging diligently and wearing zinc oxide, thanks again! (no worries, carefully sanitized tools when removing stitches)

I have had 5 stitches just taken out (after 5 days) from brow bone to outer corner of eye. There is a very pronounced lump and feels sore - and very hard. When do you think i should start to massage? And how long till the lump goes down? (i also have a lump on my cheekbone). Thankyou in advance!

Nahid, is the stitches you are talking about are "inside" and the incision has healed, then I would say yes it is a good time to begin using sunscreen. Ask you surgeon to be sure he/she agrees. Best to you.

I had Mohs about 6 weeks ago on my cheek. A flap was performed and I have a horizontal scar under my eye and a vertical scar on my cheek next to my nose. My derm told me to use Mederma, message once a day and put silicone sheets on at night. Do I need to wash off the Mederma or can I put the silicone sheet on top of the Mederma? Which one is better to use if I have to choose one? Thanks

Anon (11/06/12), use the one you prefer. The sheeting will "stick" to clean skin best so wash your face before applying. You may find it nice to use the Mederma or simply sunscreen (you will massage the scar as you apply it) during the day and use the sheeting at night. Best to you

My son 2 was bit by a dog not even an inch under his eye. The wound has finally started to scab over, it was deep enough they probably would of stitched if it had not been a dog bite. I really want to reduce scarring as much as I can. When can I start using products like maderma and sun screen on it?

DnCK, you can use Aquafor while it is healing (ie while it has the scab). You can begin to use the Mederma, sunscreen, silicone sheeting products after it is healed on the new pink skin. Best to you and your son.

Hi. Just found your blog. I had a cut on the top of my foot, 4 stitches. It travels the same direction as the bones, but now that the stitches have been out I've been noticing black running along it. Is this just the blood helping it to stitch back together? I got the cut on November 7, stitches came out on the 19th. I have railroad tracks, possibly because the wound scabbed over some of the stitches (black ones that don't dissolve). Would you suggest using vitamin E oil yet or waiting, and how long would you suggest?

J/W, use Vit E or Zmederma or a hood lotion and massage the scar by rubbing the ointment/ lotion on daily (1-3 X's a day). If you where flip flood or sandals, then use sunscreen. Important to do the first six months

Great article. Looking for products to minimize scarring on my 3-yr olds face, she fell and sustained a cut along her eyebrow needing 6 stitches. The cut is nice and straight, nearly horizontal. All but one stitch has come out now but it's been 11 days, so I can see some of that railroad track appearance (wish I'd known to get the stitches out sooner...) The pediatric er docs who stitched her up also told me to use sunscreen, so I'm planning to do that during the day as soon as the last stitch is out. What do you think of these silicone products -- prosil and/or xeragel? They seem really expensive, so I'm just wondering if they are effective. If so, I'm thinking that I would use them at bedtime. Thanks!

Anonymous (12/05/12), I don't have a favorite silicone product. What matters most is that you use the produce and do scar massage. So buy what you can afford or use Aquafor or Vit E or cocoa butter (not silicone, but less expensive). You will find that like lotions, you like the smell or feel of some better than others. This affects whether you are consistent in using the product. Best to you and your daughter.

What a great, truly informative article. Thanks so much. 8 weeks ago, I passed out, hit my face on the windowsill and crushed my nose. In doing so, I have about a 2" scar diagonally from the inside of my right eyebrow down to the inside corner of my left eye. It was sutured by a plastic surgeon in the ER and I am eternally grateful to him. Still, it is a hearbreaking (to me) scar. I have been using mepiform silicone strips 24/7 (except when working out) for the last 4 weeks (had to allow time for the healing from broken nose surgery, etc.). I know I have to be patient and allow the natural healing process to take place. The scar still feels hard and rigid to me (not keloid though). I can feel it kind of pull when I make certain facial expressions. Is this normal? Will it eventually flatten out? Anything else you would recommend other than the massage and mepiform strips 24/7? Thanks so very much for your help.

Hi doctor. Thank you for this post. I got a tiny mole removed yesterday from my upper arm, but the surgeon cut a really big area and stitched up a line more than 1 inch (I am still shocked as I have had bigger moles removed with a muchsmaller scar). The stitches are tight and between them my skin is puffed out/bumpy. Is this normal? Or a bad job? If it is a bad job, do you think I can do anything about it? Thanks in advance.

hello doctor i read your article.It is very helpful. I fell down from my bike two weeks before and had a cut just above my chin which required 2 stitches. After 6 days doctor removed them. the cut is nearly horizontal but there are 2 railroad marks at both the ends. the surrounding skin is pale pink due to scratches. The marks and scar are red in colour. when will they heal?

also in relation to the above question... my doctor has prescribed me vaniza ointment for scars. and i've started applying it.will it help? what else should i do in addition to avoiding sun exposure and applying ointment? when is it good to go for laser treatment? pls help me doctor..

Anon June 2013, these are questions you should ask you MD but it is my opinion that most scars should have a minimum of 6 months to fade before spending money on revision or laser treatment. Use sunscreen, do gentle scar massage. Take care.

My sutures were removed today and the area under my arm looks terrible I look like a member of "The Walking Dead" not sure if i have a keloid but it sure looks like it. This surgery was done to fix the scar I had before but now I think it looks 10 times worse.Any advice? I would like to send you a picture of it.

Ana, sorry to hear of your worries on your newly revised scar. Please, don't send me photos of your scar. As mentioned below in the disclaimer, I don't give individual medical advise. You can use the generalized scar treatment/prevention techniques mentioned above in the article. If you are concerned that you scar is trying to become hypertrophic or keloid early after revision, then you should ask get back with your surgeon and ask if an injection of Kenalog or other early treatment might be warranted. Best to you

Hello... unfortunately my three year old son fell on a center table and split open horizontally his left eyebrow needing "three sew stitches" I'm concerned about the scaring and hair not growing were the stitches are/were. What can I do so his left eyebrow can be normal again? :/

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